Provider Demographics
NPI:1801807987
Name:TWAIT, TAMMY (DPH)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:TWAIT
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2308
Mailing Address - Country:US
Mailing Address - Phone:913-268-8963
Mailing Address - Fax:
Practice Address - Street 1:601 E 12TH ST
Practice Address - Street 2:SUITE 227
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-2818
Practice Address - Country:US
Practice Address - Phone:816-426-5783
Practice Address - Fax:816-426-7604
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10454183500000X
KS1-11320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist